Tag Archives: birth interventions

Breastfeeding Is Priceless

4 Aug

This week countries all over the world are celebrating World Breastfeeding Week 2013. The World Alliance for Breastfeeding Action and the World Health Organization are among many organization that are providing educational materials and strategies to encourage mothers to breastfeed.

According to the CDC, although continued progress in initiating breastfeeding has been made over the last ten years in the U.S., infants are not breastfed for as long as recommended. More than 3 out of 4 mothers begin breastfeeding, but only 49% of babies are breastfeeding at 6 months and 27% at 12 months.

In an effort to educate maternity care professionals and childbearing families about the value of breastfeeding, the Coalition for Improving Maternity Services published a comprehensive fact sheet showing the evidence to support breastfeeding for mothers and all babies including premature and high-risk infants. The fact sheet shows that breast milk is the ultimate form of nutrition for babies and provides the best strategies for helping mothers initiate and maintain breastfeeding.


There Is No Substitute for Human Milk

A Coalition for Improving Maternity Services Fact Sheet 

The World Health Organization (WHO), health care associations, and government health agencies affirm the scientific evidence of the clear superiority of human milk and of the hazards of artificial milk products. The WHO and the American Academy of Pediatrics recommend that mothers exclusively breastfeed their infants for the first six months, and continue for at least a year and as long thereafter as mother and baby wish.1

Human milk provides optimal benefits for infants, including premature and sick newborns. Human milk is unique. Superior nutrients and beneficial substances found in human milk cannot be duplicated. Breastfeeding provides optimum health, nutritional, immunologic and developmental benefits to newborns as well as protection from postpartum complications and future disease for mothers.

A U.S. Healthy People 2010 goal is to have three-quarters of mothers initiate breastfeeding at birth, with half of them breastfeeding until at least the 5th or 6th month, and one-fourth to breastfeed their babies through the end of the first year.2 In 2007 only four states met all five Healthy People 2010 targets for breastfeeding.3

Maternity Care Practices Greatly Affect Breastfeeding

Labor, birth, and postpartum practices can facilitate or discourage the initiation, establishment, and continuation of breastfeeding.4, 5, 6, 7  According to the U.S. Centers for Disease Control and Prevention (CDC), many birth facilities have policies and practices that are not evidence-based and are known to interfere with breastfeeding in the early postpartum period and after discharge.8 The World Health Organization,9 the American Association of Pediatrics,10 the American Academy of Family Physicians,11 and the Academy of Breastfeeding Medicine12 recommend that maternity health professionals provide birth and postpartum care that is supportive of breastfeeding.

The World Health Organization has identified the following intrapartum mother-friendly childbirth practices as supportive of breastfeeding:

  • minimizing routine procedures that are not supported by scientific evidence;
  • minimizing invasive procedures and medications; providing emotional and physical support in labor;
  • freedom of movement and choice of positions during labor and birth;
  • staff trained in non-drug methods of pain relief and who do not promote the use of analgesics or anesthetic drugs unless required by a medical condition;
  • no unnecessary induction or augmentation of labor, instrumental delivery, and cesarean section.13

The quality of care provided in the first 24 hours after birth is critical to the successful initiation and continuation of breastfeeding. Hospitals and birth centers which encourage and support breastfeeding are more likely to care for mothers and newborns in the following ways:

  • Provide mothers with comprehensive, accurate, and culturally appropriate breastfeeding education and counseling.
  • Encourage skin-to-skin contact for at least thirty minutes between mother and baby within one hour of an uncomplicated vaginal birth or within two hours for an uncomplicated cesarean birth.
  • Give mothers the opportunity to breastfeed within one hour of uncomplicated vaginal birth and two hours of an uncomplicated cesarean birth.
  • Encourage newborns to receive breast milk as their first feeding after both uncomplicated vaginal birth and cesarean birth.
  • Perform routine newborn procedures while keeping mother and baby skin-to-skin.
  • Help mothers with breastfeeding and teach parents how to recognize and respond to their baby’s feeding cues.
  • Encourage rooming in and help the mother to be comfortable with baby care in her own room.
  • Avoid separations of healthy mothers and babies, and encourage continuous skin to skin contact. Promote as much skin to skin contact of sick babies with mothers as possible.
  • Do not give pacifiers to breastfeeding newborns, or any other supplements, formula, water or glucose water to healthy babies.
  • Do not give mothers discharge gift bags with formula samples or formula discount coupons.
  • Provide mothers with breastfeeding support after hospital or birth center discharge. Support may include: a home visit or hospital postpartum visit, referral to local community resources, follow-up telephone contact, a breastfeeding support group, or an outpatient clinic.14

Benefits of Breastfeeding for Children

Enhanced Immune System and Resistance to Infections

The infant’s immune system is not fully mature until about 2 years of age. Human milk contains an abundance of white blood cells that are transferred to the child, acting to fight infections from viruses, bacteria, and intestinal parasites.

Human milk contains factors that enhance the immune response to inoculations against polio, tetanus, diphtheria, and influenza.15

Breastfeeding reduces the incidence and/or severity of several infectious diseases including respiratory tract infections, ear infections, bacterial meningitis, pneumonia, urinary tract infections, and greatly reduces the incidence of infant diarrhea.

After the first month of life, rates of infant mortality in the U.S. are reduced by 21% in breastfed infants.

Breastfed infants are at lower risk for sudden infant death syndrome (SIDS).16

Protection Against Chronic Disease

Exclusive breastfeeding for a minimum of four months decreases the risk of Type I diabetes (insulin-dependent diabetes mellitus) for children with a family history of diabetes, and may reduce the incidence of Type 2 diabetes later in life.

Breastfed children are less likely to suffer from some forms of childhood cancer such as Hodgkin’s disease, and leukemia.

Breastfeeding reduces the risk for obesity, high blood pressure, and high cholesterol levels later in life.17

Human milk contains anti –inflammatory factors that lower the incidence of bowel diseases such as Crohn’s disease and ulcerative colitis.18

The incidence of asthma and eczema are lower for infants who are exclusively breastfed for at least 4 months, especially in families at high risk for allergies.19

Breastfeeding Premature and High-Risk Infants

Breastfeeding and banked human milk are protective and beneficial for preterm infants.

Hospitals and physicians should recommend human milk for premature and other high risk infants.20

Breast milk lowers the premature infant’s risk for gastrointestinal and infectious disease and reduces the incidence of necrotizing enterocolitis (inflammation with possible tissue death and perforation of the small intestines and colon).21

Human milk enhances brainstem maturation. Compared to premature babies who receive formula, preterm infants who receive breast milk score higher on future I.Q. tests.

Breastfeeding the premature infant reduces hospital costs and the length of hospital stay significantly.22

Benefits of Breastfeeding for the Mother

Women who breastfeed benefit from an increased level of oxytocin, a hormone that stimulates uterine contractions lowering the risk for postpartum bleeding. Women recover better with less blood loss at birth.

Exclusive breastfeeding frequently but not always delays the return of a woman’s ovulation and menstruation for a variable 20 to 30 weeks or more. This provides a natural means of child spacing for many.

Breastfeeding may enhance feelings of attachment between mother and baby.

Breastfeeding lowers a mother’s risk for developing ovarian and pre-menopausal breast cancer and heart disease, and may decrease the risk of osteoporosis later in life. The benefits increase the longer she breastfeeds.23

Breastfeeding women without a history of gestational diabetes are less likely to develop Type 2 diabetes later in life.24

The Cost of Not Breastfeeding

Private and government insurers spend a minimum of $3.6 billion dollars a year to treat medical conditions and diseases that are preventable by breastfeeding.25 Since children who are not breastfed have more illnesses, employers incur additional costs for increased health claims, and mothers lose more time from work to care for sick children.26

Coalition for Improving Maternity Services (CIMS) Fact Sheet March, 2009.


1. American Academy of Pediatrics, Committee on Breastfeeding, Breastfeeding and the Use of Human Milk, Revised, Pediatrics 115 (2005): 496-506.

2. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, (2000). Healthy People 2010, Maternal, Infant, and Child Health, 16-30. Washington, D.C. Healthy People, http://www.healthypeople.gov/Document/pdf/Volume2/16MICH.pdf

3. U.S. Centers for Disease Control and Prevention, Breastfeeding-Related Maternity Practices at Hospitals and Birth Centers-United States, 2007. Morbidity and Mortality Weekly Report, (June 13, 2008): 621-625.


4. U.S. Department of Health and Human Services. Office on Women’s Health, (2000). HHS Blueprint for Action on Breastfeeding. Washington, D.C. Office of Women’s Health

5. American Academy of Pediatrics, 2005.

6. U.S. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report, June 13, 2008

7. World Health Organization (2003). Infant and Young Child Feeding. A Tool for assessing National Practices, Policies and Programs. Geneva: WHO. http://www.who.int/nutrition/publications/infantfeeding/inf_assess_nnpp_eng.pdf

8. U.S. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, June 13, 2008.

9. World Health Organization, 2003.

10. American Academy of Pediatrics, 2005.

11. American Academy of Family Physicians (2007). Family Physicians Supporting Breastfeeding, Position Paper, http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpaper.printerview.html

12. Academy of Breastfeeding Medicine, ABM Protocols, (2006). Protocol 15: Analgesia and Anesthesia for the Breastfeeding Mother. http://www.bfmed.org/Resources/Protocols.aspx

13. World Health Organization, 2003.

14. U.S. Centers for Disease Control and Prevention. Scoring Explanation for the 2007 CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey. http://www.cdc.gov/breastfeeding/pdf/mPINC_Scoring_Explanation.pdf

15. U.S. Department of Health and Human Services. Office of Women’s Health, (2000).

16. American Academy of Pediatrics, 2005.

17. American Academy of Pediatrics, 2005.

18. United States Breastfeeding Committee, (2002). Benefits of Breastfeeding. http://www.usbreastfeeding.org/Issue-Papers/Benefits.pdf

19. Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 2008;121:183-191.

20. American Academy of Pediatrics, 2005.

21. Agency for Healthcare Research and Quality, Evidence Reports and Summaries, 2007.

22. United States Breastfeeding Committee, 2002.

23. United States Breastfeeding Committee, 2002.

24. Agency for Healthcare Research and Quality, Evidence Reports and Summaries, 2007.

25. U.S. Breastfeeding Committee (2002). Economics of Breastfeeding. http://www.usbreastfeeding.org/Issue-Papers/Economics.pdf

26. Washington Business Group on Health (March 2000). Breastfeeding Support At The Workplace, Best Practices to Promote Health and Productivity, Family Health in Brief, Issue No. 2. http://www.businessgrouphealth.org/pdfs/wbgh_breastfeeding_brief.pdf

For more references on breastfeeding, visit:

US Breastfeeding Committee: www.usbreastfeeding.org

Centers for Disease Control: www.cdc.gov/breastfeeding

La Leche League International: www.llli.org

International Lactation Consultant Association: www.ilca.org

This fact sheet was co-authored by Nicette Jukelevics, MA, ICCE, and Ruth Wilf, CNM, PhD.

© 2009 Coalition for Improving Maternity Services. Permission granted to freely reproduce with attribution.

Download a pdf of Breastfeeding is Priceless

Elective Inductions, Cesareans, and Preterm Birth

20 Nov

November is Prematurity Awareness Month when the March of Dimes (MoD) encourages care providers and the public to focus on the high number of preterm births in the United States and what can be done to reduce them. The March of Dimes, along with state and national health services are concerned that increasing elective inductions and scheduled cesareans may be contributing to the rising number of babies born preterm. Premature birth is the number one cause of newborn death in this country.

In addition to encouraging women to stop smoking, avoiding multiples from fertility treatments and providing progesterone treatments for women with a history of preterm birth, the MoD recommends avoiding unnecessary cesareans and inductions before 39 weeks and encourages women with a healthy pregnancy to wait for labor to begin on its own.

Between 1990 and 2006  the number of babies born after 39 weeks decreased sharply and the number of babies born between 36-38 weeks gestation rose sharply. Experts associate this trend with increasing rates of induction of labor and cesarean sections. An integrated health care system based in Salt Lake City, Utah reported that in 2001, 28%  of their elective deliveries were performed prior to 39 weeks.

In 2008 12.3%  of all U.S. births were preterm. Based on records from the National Center For Health Statistics, the March of Dimes developed a score card for national and state preterm birth rates. Comparing the  national preterm birth rate to the Healthy People 2020 goal of 7.6%  the MoD gave the U.S. a “D” grade.

Preterm birth is defined as a live birth before 37 completed weeks gestation. A baby born between the 34th and 36th week of pregnancy is considered  late preterm. A full term pregnancy is 40 weeks. When cesareans are scheduled or labor is induced there is a margin of error in pinpointing fetal maturity. Being born only one week earlier can make a difference in terms of complications babies are likely to suffer.

The number of cesareans increased by 71% between 1996 and 2007. The rate rose for women in all age, racial and ethnic groups. The National Center for Health Statistics  found that non-medical factors including physician practice style and women’s preferences contributed to the widespread and continuing rise of cesareans (NCHS Data Brief No. 35, March 2010).

A large percentage of the increase in preterm and late preterm singleton (one baby) births between 1996 and 2004 occurred among women who delivered by c-section.

The last few weeks of pregnancy are extremely important to a baby’s health because many organs, including the brain and lungs, are not completely developed yet. Babies born a few weeks too soon can face serious health challenges and are at risk for lifelong disabilities, such as cerebral palsy, lung problems, vision and hearing loss, and learning disabilities.

Expectant mothers however, are not aware of the importance of keeping the pregnancy full term. In a recent U.S. survey over 90% of women believed that giving birth at 39 weeks was safe, unaware of the crucial brain development that occurs in the last weeks of pregnancy. Women who agree to or choose to induce labor or schedule an elective cesarean don’t consider the additional interventions and days in the hospital that premature babies often need nor are they aware of the financial costs.

Elective inductions also increase the risk for cesarean section.

A national campaign is in full force to educate care providers, hospitals, and the public about the importance of maintaining a full term, 40 weeks, pregnancy. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the national body that accredits hospitals, recommends that hospitals track and reduce their induction rates as one criteria to gain accreditation.

On November 15, 2010 the Mineapolis – St. Paul Star Tribune reported that the Minnesota State Department of Human Services is leading the nation in discouraging birth by convenience. It has  created a policy against elective, non-medically indicated inductions by asking hospitals to establish policies to reduce convenience inductions by the year 2012.

Although the national preterm birth rate dropped 3% in the last two years, the U.S. still has one of the highest preterm birth rates in the world. Hopefully, the progress that has been made in the last two years will continue.

For additional information on the impact of labor induction and preterm birth see, Labor Induction Exposed, posted November 15, 2010 on Mother’s Advocate Blog.

Sources for this article:

March of Dimes/California Maternal Quality Care Collaborative, Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age, A California Tool Kit To Transform Maternity Care.

March of Dimes, 2010 Prematurity Birth Report Cards

March of Dimes, www.prematurityprevention.org

March of Dimes, Professional Resources

Educational Resources

U.S. Surgeon General Dr. Regina Benjamin’s message on preterm birth, video

March of Dimes, Why The Last Weeks of Pregnancy Count

Lamaze International, Let Labor Begin On It’s Own

Mother’s Advocate, Let Labor Begin On It’s Own, video